Breaking Down Evidence-Based Practices for State Policy: Using a Common Elements Approach - PowerPoint Presentation

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Breaking Down Evidence-Based Practices for State Policy: Using a Common Elements Approach in Progress Note Documentation as an Indicator of Adherence

University of Washington Department of Psychiatry and Behavioral Sciences

Sarah Cusworth Walker, PhD

Georganna Sedlar, PhD

Jessica Leith, LMFT

Lucy Berliner, MSW

Cathea Carey

, BS

Eric Trupin,

PhD

Washington State Department of Behavioral Health and Recovery

Paul Davis, MS

Felix Rodriguez, PhDSlide2
Slide3

The Evidence Based Practice Institute is a intermediary organization that supports EBP translation and implementation efforts with the WA State Department of Social and Health Services Division of Behavioral Health and

Recovery (DBHR)

for children’s mental health

. . Slide4

State Fiscal Year 2017 30%

b

enchmark for EBP services in children’s mental health

(not an inconsiderable challenge with the national average for EBP use in children’s public

m

ental health at 1-3%; Bruns, Kerns, Pullmann et al., 2013)Slide5

Defining Evidence Based Practice

Source

Purpose

Level of description

Legislative

General description

References the need for rigorous research design

Washington State

Institute for Public Policy/Evidence Based Practice Institute (EBPI)

For

inventory review

Specifies the need

for cost-benefit, heterogeneity in race/ethnic sampling, translational capacity and identifies treatment categories based on meta-analysis

Department of Behavioral Health and Recovery (DBHR)/

EBPI

For provider guidance and monitoring

Outlines the clinical components

in the research-based treatment categoriesSlide6

Monitoring the use of multiple EBPs in a cash-strapped system

2013

2013

2016 instituted after initial estimates because . . .Slide7

Without reporting guidance, numbers were suspect

EBP benchmarks are based on

encounters

rather than clients

The state error rate for reporting EBPs was 38% with a range across regions of

9 – 83%

Error was defined by

Reporting non EBP practices for children’s mental health

Reporting practices under unrelated encounter typesSlide8

Designing Reporting Guides

Challenge 1

: How to establish “good intent” to deliver an EBP

Challenge 2: How to allay provider concerns about whether their individualization/modifications of EBPs were eligible for reporting

Challenge 3

: How to minimize burden and paperwork by keeping all reporting within existing channels (billing and routine progress reporting)Slide9

Challenge 1: Establishing “good intent”Slide10

Challenge 2: Allaying provider concerns about fidelity

Diebold

et al. (2000) suggest that innovation must reflect what they call "

assimmodation

," a balance of assimilation of innovations to existing structures and accommodation of those structures to incorporate key elements.

(Elias et al., 2003)

If the state was allowing only a few interventions, questions about adaptation could be fairly well-managed with expert consultation. However, in a complex system with multiple programs, implementation is considered “good enough” for

counting

if the core philosophy and strategy of the treatment is maintained. This reflects and draws from efforts to identify core components to develop flexible treatment strategies adaptable to real world contexts:

Elias, M. J., Zins, J. E.,

Graczyk

, P. A., &

Weissberg

, R. P. (2003). Implementation, Sustainability, and Scaling up of Social- Emotional and Academic Innovations in Public Schools.

School Psychology Review, 32

(3), 303-319.

Kendziora

, K., &

Osher

, D. (2016). Promoting

Childrens

’ and Adolescents’ Social and Emotional Development: District Adaptations of a Theory of Action.

Journal of Clinical Child and Adolescent Psychology, 45

(6), 797-811. doi:10.1080/15374416.2016.1197834

FOR REPORTING PURPOSES ONLY, NOT INTENDED TO BE CLINICAL ADVICESlide11

Identifying Components

Began with treatment categories as identified by WSIPP in meta-analyses indicated as research-based on the state inventory

e.g., CBT for Anxious Children

Reviewed available taxonomies, meta-analytic studies and dismantling studies of clinical components for these categories (e.g. below)

Chorpita

, B.,

Daleiden, E., & Weisz, J. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5-10. Weisz, J. R., Chorpita

, B. F.,

Palinkas

, L. A.,

Schoenwald

, S. K., Miranda, J.,

Bearman

, S. K., . . . Gibbons, R. D. (2012). Testing standard and modular designs for

psychotherapy

treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial.

Archives of General Psychiatry, 69

(3),

274-282

.

doi:10.1001/archgenpsychiatry.2011.147

Wright, C., Catty, J., Watt, H., & Burns, T. (2004). A systematic review of home treatment services.

The International Journal for Research in Social and Genetic

Epidemiology

and Mental Health Services, 39

(10), 789-796.

doi:10.1007/s00127-004-0818-5Consulted with clinical experts to validate and refine the components“Essential” are 1) designated components that are in at least 80% of effective treatment programs for that category, 2) are reasonably distinct from other treatment category practices, 3) appear to be independently effective. “Allowable” are clinical components common to effective treatment categories that may or may not cross multiple treatments (e.g., problem solving).Slide12

Challenge 3: Minimize reporting burden and paperworkSlide13
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Feasibility Evaluation

2017-2018 Evaluation Plan

Adherence:

EBPI will roll out up to 12 regional trainings on using the Reporting Guides. Participating sites (anticipating 12-15) will be asked to provide 10-20 randomly drawn cases subsequent to the training which will be scored for adherence with the RG standard.

Acceptability

Following in person trainings, EBPI will send a survey to participants containing the EBP Attitudes Scale and questions about the acceptability of the Reporting Guides in practice

.Knowledge: An instructional web video (link below) will be disseminated through the children’s mental health network with all subcontracted agencies encouraged to have providers view and take a short knowledge-based quiz.

Anticipating 100-300 responses for assessing knowledge of how to document practice.

All participants in the live training will take the same quiz (anticipated 50-100), allowing for an assessment of training context on knowledge. Slide15

Thank you!

For inquiries:

Sarah Cusworth Walker

secwalkr@uw.edu

Acknowledgments:

Division of Behavioral Health and Recovery

Behavioral Health Organization child care coordinatorsThe Washington State Institute of Public Policy (

WSIPP/

Marna

Miller)

Ron

Gengler and staff (Comprehensive)

Melissa

Gorsuch-Clark and staff (Catholic Family and Child Services)

Suzanne Kerns

Eric Bruns

Greg

Endler